Why This Ebola Outbreak Is Different Than Earlier Versions

Aug 17, 2014
Originally published on August 17, 2014 8:56 pm
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The Ebola outbreak appears to be raging out of control in West Africa. So many people have been sickened by Ebola that it is now being called an epidemic. David Heymann is professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. He joins us from the BBC Studios in Geneva, Switzerland. Thank you very much for taking the time to talk with us, Professor Heymann.

DAVID HEYMANN: Thank you very much.

WERTHEIMER: You spent 13 years with the Centers for Disease Control in sub-Saharan Africa. I understand that you were witness to the very first known outbreak of Ebola way back in 1976 in Zaire. Could you just tell us, how did that one start?

HEYMANN: Well, in 1976, the outbreak first came to attention because four missionary nurses and one missionary medical worker, a father in a mission in the northern then Zaire became sick with a very serious disease. This outbreak occurred because the index case, that is the first case in the outbreak, had come to the outpatient clinic at the missionary hospital with a fever. He was treated with an injection thinking that he had malaria, and he went home. He came back a bit later with a nosebleed and was again treated with an injection. The problem in the hospital was, though, that the needles and syringes of which there were only four were used both in the outpatient clinic and in the maternity. And they were not sterilized between use. As a result, women who were coming into deliver were injected and became infected with Ebola as well.

WERTHEIMER: Well, how was it stopped?

HEYMANN: The outbreak stopped on its own in the middle of October because, unfortunately, most of the health workers died, the hospital closed. And when the hospital closed, the outbreak, at least the transmission in the hospital, stopped. And there wasn't a lot of spread within this very rural area of Northern Zaire.

WERTHEIMER: I gather that that's been one of the reasons why Ebola has not gotten out of control in the past - just that it tended to start in small areas.

HEYMANN: Well, that's right. And also, it depends on whether or not hospitals are ready to deal with an infection that they can't diagnose. A year after the outbreak in Yambuku in northern Zaire, there was another outbreak in a hospital in Tandala. And the doctor in charge of that hospital, also a missionary hospital, had been helping at the outbreak in Yambuku. When he saw this case, he isolated it immediately and made sure that there was extremely good protection of the health workers in the hospital. And there was only one other case. And that was the sister of the patient. So there were only two cases in that outbreak, and that clearly showed that Ebola is amplified in its transmission in a hospital where practices are not being adhered to.

WERTHEIMER: Is there a difference, do you think, now that Ebola has migrated across borders and has been migrated into densely populated cities like Lagos and Nigeria? What is that going to mean for trying to contain this disease?

HEYMANN: Well, what it means is that there has to be certainly an increased effort on the three areas that can prevent and stop outbreaks. And that is infection control in hospitals, community understanding and contract tracing and fever surveillance.

WERTHEIMER: If the incidence of Ebola - if the numbers of patients in a major metropolitan area grows, how long do you think it will take to get hold of this thing to stop it?

HEYMANN: Well, it will take quite a while now because this disease has spread quite rapidly and penetrated quite well in urban areas. I can't give your projection of how long it will take. It's a complex issue. It's a very important issue. It's the most important health issue in the world at present. And it must be dealt with properly or economies are going to begin to really have difficulty in sustaining themselves in the long-term.

WERTHEIMER: In the past when there were outbreaks in small places, in rural villages, that kind of thing, it seemed as if what stopped the disease was that everyone who was going to die of it did die of it. And then it stopped. Now it's unimaginable that something like that of sort of that kind of a process could be applied to an area where millions of people live.

HEYMANN: Well, I think it's too simple to say that when people - enough people died, the outbreak stopped because these outbreaks were managed in a way that contacts were traced, that people were isolated. It was not just the fact that they did die out eventually. This outbreak has certainly not done that. It started in a rural area. The rural area was not able to deal with this. It was not able to stop it. And so now it's spread internationally. And it's a much different scale and on a much different level than any previous Ebola outbreak. But it will be a long time until this outbreak is controlled.

WERTHEIMER: Professor David Heymann helped stem the first known outbreak of the Ebola virus in Zaire in 1976. He is now at the London School of Hygiene and Tropical Medicine. Thank you very much for talking to us about this.

HEYMANN: Thanks very much. Transcript provided by NPR, Copyright NPR.